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Chronic permanent dial station dilatation of bronchi and bronchioles due to infection and inflammation which causes destructive and obstructive effect  in airway. this is a secondary irreversible disease. Not a primary disease.

Most commonly due to tuberculosis. United status most commonly due to cystic fibrosis

Pathophysiology

Infections of the lung tissues leads to inflammation of the tissues. therefore it will leads to local tissue destruction. the destruction of local tissue main course increase secretion of exudate and also destruction of soft tissues of lungs. increased secretion of mucous exudate may leads to obstruction of airways. it also causes again infection. destruction of lung tissues may lead abnormal irreversible dilatation  of the airways and alveoli.

Causes

1.Cystic fibrosis

Problem in CFTR gene. It will lead to Defect in chlorin channels.causing stoppage of excretion of   chlorin ions.so chlorin will  stagnate in the lung tissue cells. But more sodium ion and water come into the cells. Therefore secretion will become thick and viscose. So cillia can’ t move properly.obstruction will occur.

2.Chronic infections

Distruction in all  the lung tissues. It will lead to abnormal dilatation of of airway and alveoli. Pus formation will  occur. finally it will leads to obstruction.

3.Tumours

 tumors will cause directly obstructions in the airway.

4.Katagenous syndrome ( Primary cilliary dyskinesia)

In here Cillia will not work properly. So mucous accumulation will occur.

5.Allergic bronchopulmonary aspergillosis

6.Bronchial narrowing or obstruction

7.COPD ( chronic obstructive pulmonary diseases)

8.Aspiration

9.Immuno deficiency

Normal air rim is 2-3 cm. But here due to saccular and tubular dilatation air rim will be decreased.

What Causes Bronchiectasis?

Clinical features

1. Cough  full of pus( muco purulent sputam with copious amount)

2. Smelly sputum

3. Hemoptysis

4. Clubbing fingers

5. Shortness of breath

6. Rhino sinusitis

7. Non specific symptoms as low grade fever, malaise, fatigue, dizziness.

Bronchiectasis - Wikipedia

Investigations

  1. CXR- chest x-ray- tram track appearance

             a)Thin walled cyst

            b)Honey comb appearance

2. HRCT – Thick bronchial wall

           a) Signet ring appearance

           b)Tram track line due to inflammation and fibrosis.

3. Sputum culture

4. CBC – ( complete blood count) anemia can be noticed. Increased WBC count, in rare cases HIV test can be done if it is due to immune

deficiency..

5.Pulmonary function test ( PFT)- This is a obstructive pulmonary disease. So FEV1/ FVC is less than 70 %.

Bronchoscopy also benifitial.

If the patient has heamoptysis it is a critical condition. Alarming sign of surgery.

Complications – are cor- pulmonale, pulmonary hemorrhage, plural emphysema, lung abscess and also carcinoma of the lung tissues.

Bronchiectasis Ct Scan Chest - ct scan machine

Management

1.Should maintain the bronchial and pulmonary hygein should be maintained

2.Chest physiotherapy can be done.

3.Anti biotic treatment should be given

4.Stoppage of smoking is most important.

5.Vaccination can be given

6.BAL

Treatment – for treat the bronchiectasis lobectomy can be done. As well as in severe conditions lung transplantation also benifitial.pulmonery arterial embolization also used for the treatment program of bronchiectasis. Normally treatment of bronchiectasis is initiated with ani biotic treatment and postural drainage. Through the postural drainage sputum is expelled out from airways and lungs. With these treatments also should treat the underlying cause.

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